Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements—Part 1

摘要

More than 2 decades ago, the National Academies of Medicine (NAM; previously known as the Institute of Medicine) published a report exposing wide gaps in the quality of care and services received by people of color in the United States. Effective January 1,2023, the Joint Commission's (TJC) accredited hospital programs are required to meet new standards for leadership and performance that are designed to address health care disparities as a quality and safety priority. This current TJC Standard (LD.04.03.08) will be elevated to a National Patient Safety Goal (NPSG) in July 2023 and will be known as NPSG Goal 16: Improve health care equity (NPSG.16.01.01). Nurses in clinical settings face challenges in the assessment and measurement of health equity in everyday practice, in many cases due to complex situational and contextual factors beyond their reach. For example, the location for documentation of factors affecting health equity such as patients' inability to pay for medications or secure transportation for follow-up are not readily accessible in the nursing flowsheets of electronic health records (EHRs). Similarly, social and economic barriers to care, known as health-related social needs (HRSNs), are often unrecorded or recorded on a problem list as "resolved" after a referral is made, when in fact, the referral itself is not necessarily a resolution. These barriers and others like them make health equity difficult to measure, monitor, and evaluate because many requisite data elements are missing or buried in nondiscrete documentation fields that are not easily searched or retrieved in the EHR.